Provider Demographics
NPI:1760004394
Name:GILGAL ENTERPRISE LLC
Entity Type:Organization
Organization Name:GILGAL ENTERPRISE LLC
Other - Org Name:GILGAL HOME ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OSABUOHIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EREGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-562-8367
Mailing Address - Street 1:2968 VOLTURNO DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8731
Mailing Address - Country:US
Mailing Address - Phone:682-248-3801
Mailing Address - Fax:817-459-1220
Practice Address - Street 1:2968 VOLTURNO DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8731
Practice Address - Country:US
Practice Address - Phone:682-248-3801
Practice Address - Fax:817-459-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility